<section class="content">
	<div class="row">
		<!-- left column -->
		<div class="col-md-12">
          <div class="box box-primary box-solid">
            <div class="box-header">
              <h3 class="box-title">新参保</h3>
            </div>
            <div class="box-body">
				<form id="form" class="form-horizontal form-row-seperated" method="post" ng-submit="submit(data, data3);">
					<div class="form-body">
						<div class="form-group last">
							<div class="row">
								<label class="control-label col-md-2"><span class="data_text_star">*</span>姓名：</label>
								<div class="col-md-3">
									<input class="form-control" ng-model="data3.CA001" type="hidden" readonly>
									<input class="form-control" ng-model="data3.CA003" type="text" readonly> 
								</div>
								<label class="control-label col-md-2"><span class="data_text_star">*</span>身份证号：</label>
								<div class="col-md-3">
									<input class="form-control" ng-model="data3.CA006" type="text" readonly> 
								</div>
							</div>
							</br>
							<div class="row">
								<label class="control-label col-md-2"><span class="data_text_star">*</span>参保行政区划：</label>
								<div class="col-md-3">
									<select class="form-control required" name="intoAddress" ng-change="organClick(data.intoAddress,data.AAC009)" ng-model="data.intoAddress"> 
										<option value="">请选择</option>
										<option ng-repeat="d in data" value="{{d.AAB301}}">{{d.AAA146}}</option>
									</select> 
									
								</div>
								<label class="control-label col-md-2"><span class="data_text_star">*</span>参保街道：</label>
								<div class="col-md-3">
									<select class="form-control required" name="intoVillage" ng-change="organVillageClick(data.intoVillage)" ng-model="data.intoVillage"> 
										<option value="">请选择</option>
										<option ng-repeat="d in data1" value="{{d.AAB301}}">{{d.AAA146}}</option>
									</select>  
								</div>
							</div>
							</br>
							<div class="row">
								<label class="control-label col-md-2"><span class="data_text_star">*</span>参保村（居）委会：</label>
								<div class="col-md-3">
									<select class="form-control required" name="intoStreet" ng-model="data.intoStreet"> 
										<option value="">请选择</option>
										<option ng-repeat="d in data2" value="{{d.AAB301}}">{{d.AAA146}}</option>
									</select>  
								</div>
								<label class="control-label col-md-2"><span class="data_text_star">*</span>户口性质：</label>
								<div class="col-md-3">
									<select class="form-control required" name="AAC009" ng-model="data.AAC009" ng-change="aac009Click(data.intoAddress,data.AAC009)"> 
										<option value="10">非农业户口</option>
										<option value="20">农业户口</option>
									</select>  
								</div>
							</div>
							</br>
							<div class="row">
								<label class="control-label col-md-2"><span class="data_text_star">*</span>个人身份：</label>
								<div class="col-md-3">
									<select class="form-control required" name="AAC012" ng-model="data.AAC012"> 
										<option value="1">工人</option>
										<option value="2">农民</option>
										<option value="3">学生</option>
										<option value="7">无业人员</option>
										<option value="9">其他</option>
									</select>  
								</div>
							</div>
							</br>
							<div class="row">
								<label for="exampleInputFile" class="control-label col-md-2">
									<span class="data_text_star">*</span>身份证照片（选择有效的身份证正面）：</label>
								<div class="col-md-4">
									<input type="file" id="exampleInputFile" style="padding:10px 0px;" class="required"
										 name="exampleInputFile" accept=".jpg,.JPG,.png,.PNG">
								</div>
							</div>
							</br>
							<div class="row">
								<label for="exampleInputFile" class="control-label col-md-2">
									<span class="data_text_star">*</span>身份证照片（选择有效的身份证反面）：</label>
								<div class="col-md-4">
									<input type="file" id="exampleInputFile1" style="padding:10px 0px;" class="required"
										 name="exampleInputFile1" accept=".jpg,.JPG,.png,.PNG">
								</div>
							</div>
							</br>
							<div class="row">
								<label for="exampleInputFile" class="control-label col-md-2">
									<span class="data_text_star">*</span>户口本图片（选择有效的户口本）：</label>
								<div class="col-md-4">
									<input type="file" id="exampleInputFile2" style="padding:10px 0px;" 
										class="required" name="exampleInputFile2" accept=".jpg,.JPG,.png,.PNG">
								</div>
							</div>
							</br>
							<div class="row">
								<label class="control-label col-md-2"><span class="data_text_star">*</span>缴费档次：</label>
								<div class="col-md-3">
									<select class="form-control required" name="AAZ289" ng-model="data.AAZ289"> 
										<option value="">请选择</option>
										<option ng-repeat="d in data4" value="{{d.AAZ289}}">{{d.AAA044}}</option>
									</select>  
								</div>
								<label class="control-label col-md-2"><span class="data_text_star">*</span>联系人姓名：</label>
								<div class="col-md-3">
									<input class="form-control required" name="AAE004" ng-model="data.AAE004" type="text"placeholder="请输入联系人姓名"> 
								</div>
							</div>
							</br>
							<div class="row">
								<label class="control-label col-md-2"><span class="data_text_star">*</span>联系电话：</label>
								<div class="col-md-3">
									<input class="form-control required isPhone" name="AAE005" ng-model="data.AAE005" type="text" placeholder="请输入联系电话"> 
								</div>
								<label class="control-label col-md-2"><span class="data_text_star">*</span>联系地址：</label>
								<div class="col-md-3">
									<input class="form-control required" name="AAE006" ng-model="data.AAE006" type="text" placeholder="请输入联系地址"> 
								</div>
							</div>
						</div>
					</div>
					<div class="box-footer">
						<button type="submit" class="btn btn-primary">
							<i class="fa fa-check"></i>保存
						</button>
					</div>
				</form>
				

            </div>
            <!-- /.box-body -->
          </div>
          <!-- /.box -->
        </div>
	</div>
</section>